How to destroy an ED physician’s productivity…

No one sets out to sabotage physician productivity. But there are some common decisions made every day that have a very large, negative impact on that productivity:

Software /EMR: We’ve said it hundreds of times and I will say it again. It is 2017. No software package or upgrade should be considered unless it results in LESS time in front of a computer performing data entry. Physicians (and nurses for that matter) are shackled to computers clicking, typing, and dictating. Newer systems always seem to make the number of steps in each task an afterthought. It is time for that to change. Stop eating up valuable time that belongs to the patient. If a company cannot prove that their product improves efficiency, look elsewhere. And don’t allow the burden of proof to be on the hospital or physician. Each of these developers is well aware of their competition and should be making it a priority to improve the user’s efficiency.

Dictation Systems: Do you still have a dictation system that relies on human beings to transcribe audio recordings? Do you realize the amount of time the ED physician is spending listening to recordings of half asleep radiologists dictating (or mumbling) reports? Stop the madness. Simplify the interface with the dictation system, or better yet, get rid of it. Delayed transcription is a thing of the past. We live in a 24/7 healthcare delivery environment where there is no role for this process any longer.

Admission Tag: Every specialty is moving towards becoming a “consultation only” service. No one wants to do the work of a standard H&P and discharge summary. Certainly no one wants to be bothered with calls regarding the patient’s meds, labs, or comfort. So every patient is pushed to a primary medical team with specialty consultation. Everyone may be on board with the system, but if it requires several calls to each specialist and an admitting team, who pays the price? The ED physician. Time spent on the phone is time away from the next patient. Keep the process simple.

Communication Pong: I can’t find a nurse so I’ll leave a paper note at her workstation. The nurse can’t locate me so she types a note into the tracking screen. Neither of us realize we are looking for each other and meanwhile the only thing benefitting is our Fitbit step count. I carry a smart phone in my pocket with access to medical references and 25 different messaging, voice, and email apps. Why are we still hunting for each other? If you work in an ED that sees more than 2 patients per hour, you need to find a reliable device or app (there are many HIPAA compliant ones out there) to help your staff communicate. It may cost you a few dollars but the return in efficiency will more than pay for the service.

Geography: Nurses are assigned patients in consecutive rooms because it improves their efficiency. Why then do we think it is ok to make our physicians run back and forth across the entire emergency department? This may not be an issue in smaller EDs, but the larger departments should make the effort to staff in teams and assign patients in geographical clumps. Call them units, pods, hallways, or tracks. Just keep the running to a minimum. The same barriers to productivity that apply to nurses also apply to physicians. Make sure you are evaluating both.

Checking Results: If you are old enough to remember the days when email began and computers required telephone modems, you’ll recall the lengthy process of connecting to your email account just to discover that there was nothing new waiting for you. Then came the miracle of AOL’s “you’ve got mail”. In what seems like a lifetime later, we still see systems requiring the user to check for results or messages. Labs, radiology reports, vital sign abnormalities, critical results, and order completion all should be pushed to the physician. A good scribe will tell you that half their time is spent checking the status of tests and tracking down results. Be cognizant of how information is brought to the attention of your physicians and move away from any system that requires a user to initiate the process first.

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Great post Sam thanks for the thoughtful details ! I was in a hospital yesterday and saw all team members carrying around communication devices that looked like the handsets of the 90’s. On so many points above you are right on the money!